I have a young gentleman who had a penile trauma at his twenties that led to whole penile loss. A reconstructive surgery had been carried out at USA with a penile prothesis implanted within the neo-phallus created. 10 years later the prothesis failed mechanically and it has been replaced by a visiting urology consultant. now its the second time that the prothesis (single sided cylinder) failed and the cylinder is always erect, despite many trials by the patient to deflate.The question is weather to re operate and change or not? , One side cylinder inflatable or a malleable (with the risk of devitalizing the skin covering. RK, MD
Dear Dr. RK, In the world of inflatable implants in a neo-phallus, the first 10 year survival is commendable. Neo-phallus or not, some patients either are not shown how the properly deflate their implant, even squeezing the shaft may help, or some are enamored with a longer penis and tend to keep it in the erect mode concealed against their pubis or along the inner aspect of their thigh as with a semi-rigid. The problem may be as simple as the cylinder being left in the erect mode with capsular contracture around the reservoir. If you know by the operative note the reservoir size, how much fluid was put in the reservoir with the cylinder at “zero” pressure, an ultrasound may volumetrically diagnose the problem. Lysis of the capsule can often be done by simply accessing the connecting tubing, over-inflating the reservoir by about 15% and then allow it to contract to is normal volume. Release the excess from the cylinder, allow it to become flaccid once again, and reconnect.. If this doesn’t work, would consider explanting the old reservoir and inserting new one. The only other contemplation is the erect cylinder may have stretched his phallus, so if this were a routine case, one might consider a longer cylinder perhaps but I wouldn’t go there necessarily. Once reconnected, cycle it a few times before closing to make sure it works. Spare if at all possible more surgery on a neo-phallus.. Cordially, Harold M. Reed, M.D.